The diagnosis of CIPO requires at least 2 out of 4 of the following: (i) Objective measure of small intestinal neuromuscular involvement (manometry, histopathology, transit study); (ii) Recurrent and/or persistently dilated loops of small intestine with air fluid levels; (iii) Genetic and/or metabolic abnormalities definitively associated with CIPO; (iv) Inability to maintain adequate nutrition and/or growth on oral feeding (needing specialised enteral nutrition and/or parenteral nutrition support) [25]. Laboratory tests are clinically useful to evaluate secondary forms of CIPO, some of which can be potentially curable. A full blood count, electrolytes, albumin, renal and liver enzymes, fasting cortisol, thyroid function tests, inflammatory indices, tests for diabetes mellitus (serum glucose, HbA1C) and coeliac disease (tissue Transglutaminase [tTG], total IgA) may be valuable in all cases. Cytomegalovirus, Epstein–Barr virus or other neurotropic viruses, capable of infecting enteric neurons, should be sought in patients with immunodeficiency states. Connective tissue and skeletal muscle disorders (ANA, anti-ds-DNA, SCL-70, creatine phospho- kinase, aldolase), and circulating anti-neuronal antibodies might be of aid to clinicians especially in those cases with abrupt onset where an inflammatory/immune-mediated ganglionitis is suspected. Contrast study of the small intestine using water soluble contrast should be routinely used in all patients with a suspicion of CIPO to exclude malrotation and organic lesions occluding the gut. Where available entero-MRI could be used instead or in addition to contrast studies. Antroduodenal manometry should be performed in all children with a presumed diagnosis ofCIPO in order to confirm the diagnosis, clarify the pathophysiology and optimise clinical management.
Author(s) Details:
Giulia Radocchia
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Bruna Neroni
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Massimiliano Marazzato
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Elena Capuzzo
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Simone Zuccari
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Fabrizio Pantanella
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Letizia Zenzeri
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy and Paediatric Emergency Department, Santobono-Pausilipon Children’s Hospital, Naples, Italy
Melania Evangelisti
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.
Francesca Vassallo
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.
Pasquale Parisi
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.
Giovanni Di Nardo
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.
Serena Schippa
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Ital
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Recent Global Research Developments in Chronic intestinal pseudo-obstruction
Review Article on CIPO:
Title: “Latest Developments in Chronic Intestinal Pseudo-Obstruction”
Summary: This review comprehensively summarizes the etiology, diagnosis, treatment, and prognosis of CIPO. It emphasizes the challenges in diagnosing CIPO due to its low incidence, non-specific symptoms, and heterogeneity. Imaging and gastrointestinal manometry are commonly used for diagnosis. Nutritional assessment and intervention play a crucial role in determining prognosis. Small bowel transplantation is a feasible treatment option for advanced CIPO patients, although long-term outcomes remain unsatisfactory [1] .
Update on CIPO:
Title: “Update on Chronic Intestinal Pseudo-Obstruction”
Summary: This article provides insights into diagnostic and management options for CIPO, considering histopathologic correlates. It highlights the difficulty in timely diagnosis, leading to prolonged symptom duration for most patients [2] .
Adult-Onset Acquired CIPO:
Title: “Chronic Intestinal Pseudo-Obstruction Due to Adult-Onset Acquired Neuropathy”
Summary: CIPO includes various diseases characterized by impaired intestinal motility. This article discusses adult-onset acquired neuropathies leading to CIPO-like symptoms despite the absence of mechanical obstruction [3] .
References
- Zhu CZ, Zhao HW, Lin HW, Wang F, Li YX. Latest developments in chronic intestinal pseudo-obstruction. World J Clin Cases 2020; 8(23): 5852-5865 [PMID: 33344584 DOI: 10.12998/wjcc.v8.i23.5852]
- Zenzeri, L., Tambucci, R., Quitadamo, P., Giorgio, V., De Giorgio, R., & Di Nardo, G. (2020). Update on chronic intestinal pseudo-obstruction. Current opinion in gastroenterology, 36(3), 230-237.
- Tayama, S., Furuta, Y., Morito, M. et al. Chronic intestinal pseudo-obstruction due to adult-onset acquired isolated hypoganglionosis with muscular atrophy in the small intestine: a case report and review of literature. Clin J Gastroenterol 17, 244–252 (2024). https://doi.org/10.1007/s12328-023-01902-x